| Ravindra Gautam, M.d., Inc. | |
|
930 W Main St Barstow CA 92311-2654 | |
| (760) 256-1004 | |
| (760) 256-1055 |
| Full Name | Ravindra Gautam, M.d., Inc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 930 W Main St, Barstow, California |
| Authorized Official Name and Position | Ravindra M Gautam (PHYSICIAN / OWNER) |
| Authorized Official Contact | 7602561004 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ravindra Gautam, M.d., Inc. Po Box 1519 Barstow CA 92312-1519 Ph: (760) 256-1004 | Ravindra Gautam, M.d., Inc. 930 W Main St Barstow CA 92311-2654 Ph: (760) 256-1004 |
| NPI Number | 1366490310 |
|---|---|
| Provider Enumeration Date | 05/04/2006 |
| Last Update Date | 05/29/2020 |
| Medicare PECOS PAC ID | 4082509229 |
|---|---|
| Medicare Enrollment ID | O20051029000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366490310 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| 208M00000X | Hospitalist | (* (Not Available)) | Secondary |
| Provider Name | Ravindra M Gautam |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891791703 PECOS PAC ID: 2163317314 Enrollment ID: I20040903001144 |
| Provider Name | Amir H Hedayati-rad |
|---|---|
| Provider Type | Practitioner - Cardiac Electrophysiology |
| Provider Identifiers | NPI Number: 1861410029 PECOS PAC ID: 3971571332 Enrollment ID: I20040924000465 |
| Provider Name | Talaat Maximous |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1649274176 PECOS PAC ID: 7618929944 Enrollment ID: I20160419001959 |
| Provider Name | Jeffrey M Demian |
|---|---|
| Provider Type | Practitioner - Podiatry |
| Provider Identifiers | NPI Number: 1922477280 PECOS PAC ID: 8820356900 Enrollment ID: I20171219000457 |
| Provider Name | Ross Talbot Quinn |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871082602 PECOS PAC ID: 4082097084 Enrollment ID: I20220823002741 |
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